Ramped-up danger

Mary BeckmanThe Baltimore Sun

Earlier this month, X Games skateboarder Jake Brown lost control of his skateboard high above the Big Air event's quarter-pipe at Staples Center in Los Angeles. He fell 45 feet to the flatter part of the ramp, feet first. He bounced as he landed and slid a few more feet down the ramp. After lying unconscious for a few minutes, he got up and walked away. Here's a medicine-and-physics look at what happened and how it could have been worse.

As injuries go, skateboarding is a middle-of-the-road sport, according to the American Academy of Pediatrics, sending 50,000 children from ages 5 to 14 to emergency rooms each year, more than from inline skating or skiing, but less than from baseball, basketball, bicycling or trampolining.

But extreme sports are a different story. Participants are trying to up the ante on danger.

"The games are exciting to the public because of the risk of injury," says Dr. Brian Sennett, chief of sports medicine at the University of Pennsylvania. "The ramps are catapulting them so high into the air that if they don't land properly, it's like falling out of a fourth-story window."

Brown survived because he landed feet first, not head first, Sennett says. Also, at the moment he lost control of his skateboard, his body was upright, not somersaulting, and was hardly spinning, says physicist and skateboarder Yung Tae Kim of DePaul University in Chicago (known as "Dr. Tae" in skateboarding circles). Both would have put him out of control, unable to plan his landing, although he could have flailed his arms to slow down, much as spinning ice skaters let their arms out to reduce speed.

Reports said Brown "pedaled his legs" while trying to decide what to do, which likely did little for him, Kim says.

When a skateboarder loses his board, Sennett and Kim say he should try to slide down the inclined wall of the ramp rather than slam into the flat part at the bottom where he'd release all the energy from his body at once.

"You want as gradual a slow-down as possible," Kim says. "Sliding on your knees or your butt or your belly - as long as you're sliding, it's not that big of a deal." The energy from falling 45 feet will get lost in bits and pieces, much as a child is safe when going down a playground slide.

Brown landed on his feet near the flat part, not the best option because he couldn't slide much, but he crumpled, releasing energy through his ankle, knee and hip joints before it got to his spine, Sennett says. If he'd landed on his spine, it could have been fractured.

Brown sustained a concussion - a bruise to the brain - but the helmet protected his head from severe injury, such as a skull fracture or a worse concussion. Elbow pads and kneepads protect the joints from scrapes; extreme skateboarders generally wear them. Kneepads also help dissipate the force of a fall when skateboarders miss a trick, often landing on their knees, legs tucked under, Sennett says. The pads have little friction with the ramp and allow the sliding that is central to dissipating the energy from the fall.

Wrist guards are also available, and several studies show they might reduce the risk of wrist injuries in snowboarding, but not many extreme skateboarders wear them. Ankle braces can also be worn. But competitive skateboarders usually don't, because of the equipment's potential to affect the ability to perform. "It's a balance between functioning in protective equipment and what risks they are subjected to," Sennett says.

Skateboarders learn multiple ways to fall correctly. Sennett says they learn by watching other athletes and by trial and error. Kim says it's more intuitive: "You have to develop an instinct for it."

Injuries differ based on the skill of the skateboarder. Novices have more upper-extremity injuries and advanced skateboarders get more lower-extremity injuries: Wrist fractures are the most common for novices, while ankle sprains rank high for advanced athletes. "Novices don't have good balance and they just fall off the skateboard," Sennett says, "while advanced skateboarders miss a trick and get injured on their landing."